Barn inom barnhälsovård : studier om HUR barn gör sig delaktiga vid hälsobesök

The Swedish, Primary Child Health Care (PCHC) is a service provided for children with the purpose of promoting children’s health and development in the 0-6 years-age group. The service is provided through health visits. The children participate in these visits as actors, from their own perspective through bodily and verbal expression. Although, the children are the main consideration of in the PCHC service, their perspectives and perceptions of this setting have not been explored. The aim of this thesis was to explore and describe three-, four- and five-year-old children’s expressions of participation in various situations in PCHC visits (I, II, III), and to describe five-year-old children’s perceptions of undergoing an immunization (IV). In Study I, II and III video observations and a hermeneutic approach were used to capture the children’s expressions in the various situations. To understand the children’s various perceptions of undergoing an immunization procedure, drawings and reflective talks were used from a phenomenographic approach (IV). The same children were invited to take part in the different studies due to ethical considerations. In Studies I and II the expressions of 28 children were analysed, and in Study III the expressions of 22 children. In Study IV 23 children took part. The findings show how the children in joint action with the nurse and a parent progressed through various states (I); from a state of getting ready, to a state of being ready and further to a state where they strengthened their own self. The children could also be in a state of not being ready and of being adverse. In these various states the children used various strategies as tuning in (III), affirmative negotiation (II, III) and delaying negotiation strategies (II, III). In study IV, three different perceptions of undergoing the immunization were identified among the children; It wasn’t frightening, it didn’t hurt, it felt good; It was frightening, I believed it would hurt, I had to deal with it; and I wanted to get away, It hurt. Recognizing children’s perspective and perceptions will help nurses to act with sensitivity when inviting children and guiding them through health visits. The thesis will also contribute to the development of a child-centred care and the promotion of children’s right to participate

Adverse drug reactions associated with amitriptyline - protocol for a systematic multiple-indication review and meta-analysis

Background: Unwanted anticholinergic effects are both underestimated and frequently overlooked. Failure to identify adverse drug reactions (ADRs) can lead to prescribing cascades and the unnecessary use of over-thecounter products. The objective of this systematic review and meta-analysis is to explore and quantify the frequency and severity of ADRs associated with amitriptyline vs. placebo in randomized controlled trials (RCTs) involving adults with any indication, as well as healthy individuals. Methods: A systematic search in six electronic databases, forward/backward searches, manual searches, and searches for Food and Drug Administration (FDA) and European Medicines Agency (EMA) approval studies, will be performed. Placebo-controlled RCTs evaluating amitriptyline in any dosage, regardless of indication and without restrictions on the time and language of publication, will be included, as will healthy individuals. Studies of topical amitriptyline, combination therapies, or including <100 participants, will be excluded. Two investigators will screen the studies independently, assess methodological quality, and extract data on design, population, intervention, and outcomes ((non-)anticholinergic ADRs, e.g., symptoms, test results, and adverse drug events (ADEs) such as falls). The primary outcome will be the frequency of anticholinergic ADRs as a binary outcome (absolute number of patients with/without anticholinergic ADRs) in amitriptyline vs. placebo groups. Anticholinergic ADRs will be defined by an experienced clinical pharmacologist, based on literature and data from Martindale: The Complete Drug Reference. Secondary outcomes will be frequency and severity of (non-)anticholinergic ADRs and ADEs. The information will be synthesized in meta-analyses and narratives. We intend to assess heterogeneity using metaregression (for indication, outcome, and time points) and I2 statistics. Binary outcomes will be expressed as odds ratios, and continuous outcomes as standardized mean differences. Effect measures will be provided using 95% confidence intervals. We plan sensitivity analyses to assess methodological quality, outcome reporting etc., and subgroup analyses on age, dosage, and duration of treatment. Discussion: We will quantify the frequency of anticholinergic and other ADRs/ADEs in adults taking amitriptyline for any indication by comparing rates for amitriptyline vs. placebo, hence, preventing bias from disease symptoms and nocebo effects. As no standardized instrument exists to measure it, our overall estimate of anticholinergic ADRs may have limitations